Why is healthcare so difficult in the United States? You could probably write an entire book trying to answer that question and many people have. Working in the industry for more than 20 years, I’ve struggled with that question because there are hundreds of reasons big and small that contribute to the complexity of our system. Yet, one thing has always struck me as a fundamental barrier toward making progress toward a better way: as a country, we do not agree on a simple, common definition of what healthcare is.
In doing some research for this blog post, I came across an article from 1990 that is titled “Americans' Views on Health Care: A Study in Contradictions.” More than 30 years later, we remain in the same situation. We're deeply conflicted on what having healthcare really means.
Let me explain why in this quick video:
Improving and simplifying healthcare is a tall order when you can’t get past whether healthcare is a human right that society should support for everyone with public funding. This survey data from HealthPocket illustrates that problem:
So, 70% agree that health insurance (the gateway to getting care in the U.S.) is a human right, but only 35% of Americans feel strongly enough about that to pay for the costs to provide it. And of those who would pay, the vast majority would only be willing to spend $50. In 2022, $50 doesn’t buy much in the way of care.
Gallup’s historical data points out that sentiment hasn't fundamentally changed much since 2001:
Where do we go from here?
Until we can more definitively agree on exactly what healthcare is at it's core – a product, an employment benefit or a guaranteed right – we’ll be stuck making incremental changes that bring only minor improvements.
That’s not a pretty reality, but we need to be honest about what’s holding back more expansive change.
And factors like price transparency, technology and new entrants into the industry will not be able to to make sweeping changes to a system that's core elements are in dispute among many parts of the society it is supposed to serve.
I don't know if we'll reach a definitive conclusion in the next decade, but it's the national discussion we need to have.